What Really Happens

Cosmetic laser procedures fall into three categories--purely aesthetic, remedial (tattoo removal), and surgery substitute--all of which are now commonplace at facilities such as the Mezzanine Spa, part of Soho Integrative Health in New York City. Thursday is "laser day" here. Laurie Polis, M.D., the dermatologist who's the spa's medical director, is dressed in high heels and a flame-red lace tank top, her hair pulled into a Pebbles Flintstone-style ponytail. She zips through the laser zapping--at least a dozen people before lunch--with a jocular banter belying the fact that the patients have just signed a surgical consent.

Everyone in the room is wearing protective glasses, and Dr. Polis dons a coal miner's hat with a mounted light, the better to see the small brownish spots on the face and legs of Amelia, who's squeezing a "squishy" toy, the medi-spa equivalent of biting the bullet. (Patient names have been changed.) Removing the spots is an act of vanity--they're not dangerous; they're not growing; they're not anything but unattractive. "What about these?" asks Amelia, pointing out certain other bothersome markings. "No, they're red; that's different," says Dr. Polis. "I'll be glad to do them later." Each time the alexandrite laser is pulsed, little wisps of smoke come off Amelia's skin and a powdery substance is left behind. ("Vascular lesions don't usually make a powder," says the doctor, "but the superficial brown stuff does.") Amelia takes home an antibacterial cream--it's counterintuitive, but keeping the lasered areas moist promotes faster healing by preventing scab formation. That allows new epidermal cells to migrate to the surface instead of digging under the scab. "Basically, we want to keep the treated area in a bath," says Dr. Polis.

Next up is Susanna, who no longer wants a snake encircling her upper arm (although, unaccountably, she's keeping those around her wrists, which she calls her "Cartiers"). A tattoo is like a boulder of pigment and the laser is like a hammer, with successive sessions reducing the boulder to rocks, pebbles, grain, and finally sand, at which point the body's own scavenger cells, called macrophages, will, like Pac-Men, dispose of the detritus. It seems to be uncommon knowledge that removing a tattoo hurts even more than having it put on, and Susanna is visibly miserable but still urges the doctor to go at the snake aggressively with the Nd:YAG laser. Dr. Polis explains that she can't work on the entire circumference of the arm in one session: If there were a lot of swelling, it would be like a tourniquet, compromising circulation. Susanna will have to wait a month for another treatment--sooner is generally fruitless, according to Dr. Polis. (But even a laser can't completely remove a tattoo, which may surprise the adult Americans who have them, 16 percent according to a recent Harris Poll.)

The blue nevus (a type of mole) on the forehead of Dr. Polis's next case is a cue for her diatribe against aestheticians who wield lasers but haven't been trained to recognize skin cancer. "How do they know it's not a melanoma?" she asks rhetorically. Peter's mole is merely a superficial blight, and a little rivulet of tears runs down his cheek as the Nd:YAG laser goes to work. "I know I'm torturing you, but you'll love me later," Dr. Polis promises. "And I'd love to get my hands on those blood vessels around your nose--get rid of those old-man things. It's so gorgeous when they peel off."

But the most challenging target today may be the inner thighs of Gloria, a woman of a certain age who's had a botched thigh tuck (performed by another doctor). Her legs are lifted high in the air so that the pulsed-dye laser can try to ameliorate the particularly unsightly scars. "We only do this on patients who take yoga," jokes Dr. Polis, but privately she expresses anger at Gloria's predicament.

Almost everyone spends a little post-laser time recovering with an ice pack, in mild to severe discomfort, and not exactly ready for their close-ups, Mr. DeMille.